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Amro C, Ryan I, Lemdani MS, Bascone CM, McAuliffe PB, Desai AA, McGraw JR, Broach RB, Kovach SJ, Fischer JP. Mesh exposure after ventral hernia repair with onlay biosynthetic mesh: a retrospective review of associated risk factors and management strategies. Hernia 2024:10.1007/s10029-024-03108-7. [PMID: 39304545 DOI: 10.1007/s10029-024-03108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Although intraperitoneal and retromuscular mesh placement in ventral hernia repair (VHR) are associated with lower recurrence rates, the onlay plane remains a well-established option for certain clinical scenarios. A knowledge gap remains regarding resorbable biosynthetic onlay mesh and mesh exposure. We aim to determine exposure rate, risk factors, and treatment options. STUDY DESIGN A single-center, two-surgeon retrospective review was performed examining patients who underwent VHR with onlay, Poly-4-hydroxybutyrate (P4HB) mesh from 2015 to 2021. Demographics, operative characteristics, outcomes, and mesh exposure management were analyzed. RESULTS Of 346 patients, 15 (4.3%) experienced mesh exposure. The mean age was 53 years and BMI of 33.6 kg/m2. Patients were majority ASA class 3 (65%), female (64.2%), and averaged a defect size of 307.9 ± 235.2 cm2. Independent risk factors included diabetes (AOR = 4.3,CI 1.5-12.5;p < 0.005) and COPD (AOR = 5.2,CI 1.3-21.8;p = 0.02). Mesh exposures were identified as outpatient (20%) or intraoperative (80%). All underwent operative debridement, in which nine were managed with skin reclosure, two with partial closure, and four healed by secondary intention. Five patients required excision of unincorporated mesh. Four patients required further debridement from chronic surgical site occurrences; however, all mesh exposure patents healed after a mean of 260.8 ± 313.2 days and retained original mesh. The recurrence rate was 6.7% for mesh exposure patients. CONCLUSION When faced with mesh exposure, resorbable biosynthetic mesh placed in onlay fashion was retained in all patients. Patients with a history of diabetes or COPD have increased risk of mesh exposure and should be counseled.
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Affiliation(s)
- Chris Amro
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, N.Y, USA.
| | - Isabel Ryan
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Mehdi S Lemdani
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Corey M Bascone
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Phoebe B McAuliffe
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Abhishek A Desai
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - J Reed McGraw
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, PCAM South Pavilion 14th Floor, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Van Rest KLC, Gielen MJCAM, Warmerdam LM, Kowalik CR, Roovers JPWR, Zwaans WAR. Prediction of successful revision surgery for mesh-related complaints after inguinal hernia and pelvic organ prolapse repair. Hernia 2024; 28:401-410. [PMID: 36753034 PMCID: PMC10997688 DOI: 10.1007/s10029-023-02748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE With this retrospective case series, we aim to identify predictors for reduction of pain after mesh revision surgery in patients operated for inguinal hernia or pelvic organ prolapse with a polypropylene implant. Identifying these predictors may aid surgeons to counsel patients and select appropriate candidates for mesh revision surgery. METHODS Clinical records before and after mesh revision surgery from 221 patients with chronic postoperative inguinal pain (CPIP) and 59 patients with pain after pelvic organ prolapse (POP) surgery were collected at two experienced tertiary referral centers. Primary outcome was patient reported improvement of pain after revision surgery. A multivariable logistic regression model was used to specify predictors for pain reduction. RESULTS The multivariable logistic regression was performed for each patient group separately. Patients with CPIP had higher chances of improvement of pain when time between mesh placement and mesh revision surgery was longer, with an OR of 1.19 per year. A turning point in chances of risks and benefits was demonstrated at 70 months, with improved outcomes for patients with revision surgery ≥ 70 months (OR 2.86). For POP patients, no statistically significant predictors for reduction of pain after (partial) removal surgery could be identified. CONCLUSION A longer duration of at least 70 months between implantation of inguinal mesh and revision surgery seems to give a higher chance on improvement of pain. Caregivers should not avoid surgery based on a longer duration of symptoms when an association between symptoms and the location of the mesh is found.
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Affiliation(s)
- K L C Van Rest
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - M J C A M Gielen
- Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
| | | | - C R Kowalik
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Bergman Clinics Vrouw, Amsterdam, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
| | - J P W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Bergman Clinics Vrouw, Amsterdam, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
| | - W A R Zwaans
- Department of Surgery, Máxima Medical Center, Veldhoven/Eindhoven, The Netherlands
- Research Consortium Mesh, Utrecht, The Netherlands
- SolviMáx, Center of Excellence for Abdominal Wall and Groin Pain, Eindhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht UMC+, Maastricht, The Netherlands
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Hajibandeh S, Qayum MK, Hajibandeh S, Bodkhe K, Nawaz G, Faridi N, Peixoto D, Kar I. Complete Versus Partial Excision of an Infected Mesh Following Abdominal Wall Hernia Repair: A Systematic Review and Meta-analysis. Am Surg 2023; 89:4344-4352. [PMID: 35722833 DOI: 10.1177/00031348221109816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair. METHODS A systematic search of electronic databases, including MEDLINE, EMBASE, CINAHL, and CENTRAL, and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Surgical site infection chronic sinus formation, recurrent hernia, and need for reoperation were the evaluated outcome measures. RESULTS Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: .36; 95% CI, .16-.81, P = .01), chronic sinus formation (OR: .11; 95% CI, .02-.71, P = .02), and reoperation (OR: .10; 95% CI, .03-.33, P = .0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI .62-25.44, P = .15) between two groups. The between-study heterogeneity was moderate in all the analyses. CONCLUSIONS Complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
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Affiliation(s)
- Shahin Hajibandeh
- Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Mohammed K Qayum
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Shahab Hajibandeh
- Department of Hepatobiliary and Pancreatic Surgery, University Hospital of Wales, Cardiff, UK
| | - Komal Bodkhe
- Department of Infectious Disease, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ghulam Nawaz
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Nadeem Faridi
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Dinez Peixoto
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Irfan Kar
- Department of General Surgery, Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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Schlosser KA, Warren JA. Hernia Mesh Complications: Management of Mesh Infections and Enteroprosthetic Fistula. Surg Clin North Am 2023; 103:1029-1042. [PMID: 37709388 DOI: 10.1016/j.suc.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection as well as hernia recurrence when deciding on single-stage definitive reconstruction versus primary closure with delayed reconstruction.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Surgery, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA. https://twitter.com/KT_Schlosser
| | - Jeremy A Warren
- Department of Surgery, Division of Minimal Access Surgery, University of South Carolina School of Medicine Greenville, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA.
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Tomassi M, Romain B, Passot G. Commentary on "Eventration: Treatment by the intraperitoneal braced prosthesis technique", by F. Sok, R. Cohen and F. Mauvais. J Visc Surg 2023:S1878-7886(23)00063-2. [PMID: 37028954 DOI: 10.1016/j.jviscsurg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- M Tomassi
- Hospices civils de Lyon, Visceral and Oncological Surgery Department, Lyon Sud Pierre-Bénite Hospital, Pierre-Bénite, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France; Streinth Lab (Stress Response and Innovative Therapies), Strasbourg University, Inserm UMR_S 1113 IRFAC (interface recherche fondamental et appliquée à la cancérologie), 67200 Strasbourg, France
| | - G Passot
- Hospices civils de Lyon, Visceral and Oncological Surgery Department, Lyon Sud Pierre-Bénite Hospital, Pierre-Bénite, France; CICLY, University of Lyon 1 and hospices civils de Lyon, Visceral and Oncological Surgery Department, Lyon Sud Pierre-Bénite Hospital, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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Predicting rare outcomes in abdominal wall reconstruction using image-based deep learning models. Surgery 2023; 173:748-755. [PMID: 36229252 DOI: 10.1016/j.surg.2022.06.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/04/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Deep learning models with imbalanced data sets are a challenge in the fields of artificial intelligence and surgery. The aim of this study was to develop and compare deep learning models that predict rare but devastating postoperative complications after abdominal wall reconstruction. METHODS A prospectively maintained institutional database was used to identify abdominal wall reconstruction patients with preoperative computed tomography scans. Conventional deep learning models were developed using an 8-layer convolutional neural network and a 2-class training system (ie, learns negative and positive outcomes). Conventional deep learning models were compared to deep learning models that were developed using a generative adversarial network anomaly framework, which uses image augmentation and anomaly detection. The primary outcomes were receiver operating characteristic values for predicting mesh infection and pulmonary failure. RESULTS Computed tomography scans from 510 patients were used with a total of 10,004 images. Mesh infection and pulmonary failure occurred in 3.7% and 5.6% of patients, respectively. The conventional deep learning models were less effective than generative adversarial network anomaly for predicting mesh infection (receiver operating characteristic 0.61 vs 0.73, P < .01) and pulmonary failure (receiver operating characteristic 0.59 vs 0.70, P < .01). Although the conventional deep learning models had higher accuracies/specificities for predicting mesh infection (0.93 vs 0.78, P < .01/.96 vs .78, P < .01) and pulmonary failure (0.88 vs 0.68, P < .01/.92 vs .67, P < .01), they were substantially compromised by decreased model sensitivity (0.25 vs 0.68, P < .01/.27 vs .73, P < .01). CONCLUSION Compared to conventional deep learning models, generative adversarial network anomaly deep learning models showed improved performance on imbalanced data sets, predominantly by increasing model sensitivity. Understanding patients who are at risk for rare but devastating postoperative complications can improve risk stratification, resource utilization, and the consent process.
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7
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Birolini C, Faro Junior MP, Terhoch CB, de Miranda JS, Tanaka EY, Utiyama EM. Microbiology of chronic mesh infection. HERNIA : THE JOURNAL OF HERNIAS AND ABDOMINAL WALL SURGERY 2023:10.1007/s10029-023-02747-6. [PMID: 36757611 DOI: 10.1007/s10029-023-02747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/15/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Mesh infection following hernia repair is one of the most dreaded complications of hernia surgery. Mesh sinus, infected seromas, mesh extrusion, and mesh-related enteric fistulas are common complications associated with synthetic mesh. This study aimed to review the microbiota of mesh infection in 100 patients submitted to mesh explantation. METHODS We reviewed the charts of patients presenting with a history of mesh infection lasting or arising six months or more after mesh placement. All patients who submitted to abdominal wall repair with complete removal of an infected mesh and presenting a positive culture were included. The microbiology analysis was based on positive cultures obtained from the fluids and tissues surrounding the mesh or positive cultures of the mesh. Microorganisms were divided into gram-positive or gram-negative, aerobic or anaerobic, and fungi. RESULTS Pure aerobic gram-positive cultures were encountered in 50% of the patients, followed by a combination of aerobic gram-positive/gram-negative (8%) and pure gram-negative cultures (6%). Anaerobes were recovered from 31% of patients. Fungi were recovered from 6%. Staphylococcus aureus was identified in 64% of cultures, with methicillin-resistant Staphylococcus aureus present in 42% and methicillin-sensitive Staphylococcus aureus in 22%. Among aerobic gram-negative infections, six (17%) were caused by multi-resistant bacteria, including Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter baumanii, Klebsiella pneumoniae complex, and Enterobacter cloacae complex. CONCLUSION Staphylococcus aureus plays a significant role in the pathogenesis of synthetic mesh infection. Staphylococcus aureus, isolated in 64% of cultures, accounted for most single bacterial infections and was the prevalent germ in mesh sinus and infected seromas. Gram-negative infection occurred in 35%. Anaerobes occurred in 31%, commonly encountered in polymicrobial infections. Most fungi cultures happened in patients with enteric fistulas.
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Affiliation(s)
- C Birolini
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil.
| | - M P Faro Junior
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
| | - C B Terhoch
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
| | - J S de Miranda
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
| | - E Y Tanaka
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
| | - E M Utiyama
- General and Trauma Surgery, Abdominal Wall and Hernia Repair Unit, Hospital das Clinicas, Department of Surgery, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
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Wu JF, Chen J, Hong F. Intestinal erosion caused by meshoma displacement: A case report. World J Gastrointest Surg 2023; 15:114-120. [PMID: 36741064 PMCID: PMC9896497 DOI: 10.4240/wjgs.v15.i1.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A meshoma formation and erosion to the small intestine is rare. Herein, we report one case of a meshoma that was not treated early; causing it to displace and erode the small intestine, with infection, complete control of symptoms was achieved after removal of the infected patch mass, no recurrence of hernia after 2 years of follow-up.
CASE SUMMARY A 62-year-old male patient presented with recurrent abdominal pain repeatedly for 1 wk, which has worsened 2 d before admition, accompanied by fever. Five years before presentation he underwent right inguinal hernia Plug and patch repair approach. Two years ago, a computed tomography scan revealed a right lower abdominal mass with soft tissue density, measuring approximately 30 mm × 17 mm, which was diagnosed as meshoma that was not treated. The patient had poorly controlled diabetes in the past year.
CONCLUSION The formation of meshoma is rare, and that if not treated in time it might erode and require resection of the involved organ.
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Affiliation(s)
- Jin-Feng Wu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Jian Chen
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
| | - Fang Hong
- Department of Gynaecology and Obstetrics, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
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Ayuso SA, Aladegbami BG, Kercher KW, Colavita PD, Augenstein VA, Heniford BT. Coated Polypropylene Mesh Is Associated With Increased Infection in Abdominal Wall Reconstruction. J Surg Res 2022; 275:56-62. [DOI: 10.1016/j.jss.2022.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 01/02/2023]
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Dipp Ramos R, O'Brien WJ, Gupta K, Itani KMF. Events, care, and outcomes after hernia mesh explantation for infection. Am J Surg 2021; 224:174-176. [PMID: 34876254 DOI: 10.1016/j.amjsurg.2021.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mesh explantation for infection after hernia surgery sets a cascade of events that has not been previously described. The purpose of this study is to review the care of these patients and outcomes. METHODS We obtained data on all Veterans Health Administration enrollees undergoing hernia repair during 2008-2015. All mesh explantation cases were identified and manually reviewed through December 2020 to identify surgical site occurrences, re-repairs, and subsequent explantations. RESULTS We identified 332 index explantations due to infection. A first subsequent repair was performed in 82.5% (274/332); a second repair in 18.2% (50/274); a third repair in 16.0% (8/50); and a fourth repair in 25% (2/8). Overall recurrence rate over a 12 year-period was 160/332 (48.1%). CONCLUSIONS Mesh explantation due to infection sets a cascade of complications and hernia recurrences necessitating re-operation. Complications resulting from mesh explantation suggest that resolution of the initial abdominal wall infection is crucial to prevent future mesh infections.
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Affiliation(s)
- Radwan Dipp Ramos
- VA Boston Dept. of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA
| | | | - Kalpana Gupta
- VA Boston Dept. of Medicine, 1400 VFW Parkway, Boston, MA, 02132, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Kamal M F Itani
- VA Boston Dept. of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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11
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Mandujano CC, Tchokouani L, Lima DL, Malcher F, Jacob B. Robotic mesh explantation (RoME): a novel approach for patients with chronic pain following hernia repair. Surg Endosc 2021; 36:4862-4868. [PMID: 34724577 DOI: 10.1007/s00464-021-08835-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Post-herniorrhaphy pain is common with an estimated 8-10% incidence of mesh-related complications, requiring mesh explantation in up to 6% of cases, most commonly after inguinal hernia repairs. Reoperation for mesh explantation poses a surgical challenge due to adhesions, scarring and mesh incorporation to the surrounding tissues. Robotic technology provides a versatile platform for enhanced exposure to tackle these complex cases. We aim to share our experience with a novel robotic approach to address these complex cases. METHODS A descriptive, retrospective analysis of patients undergoing a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia by two surgeons between the period of March 2016 and January of 2020. The patients were evaluated for resolution of mesh related abdominal pain as well as early post-operative complications. RoME was performed with concomitant hernia repair in cases of recurrences. RESULTS Twenty-nine patients underwent a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia between March 2016 and January of 2020. Nineteen patients (65.5%) had a prior inguinal hernia repair and 10 patients (34.5%) had a prior ventral hernia repair. Indications for mesh removal included chronic pain with or without hernia recurrence. Seventeen patients (58.6%) reported improvement or resolution of pain postoperatively (63% with a prior inguinal hernia repair and 50% of patients with a prior ventral hernia repair). Five patients (17.2%) required mesh reinforcement after explantation. Nineteen patients (65.5%) underwent mesh explantation with primary fascial closure or no mesh reinforcement. The mean follow-up was 36.4 days. The most common postoperative complication was seroma formation (6.8%), with one reported recurrence (3.4%). CONCLUSION Robotic mesh explantation in challenging cases due to the effect of chronic scarring, adhesions and mesh incorporation to the surrounding tissues is safe and provides an advantageous platform for concomitant hernia repair in these complex cases.
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Affiliation(s)
- Cosman Camilo Mandujano
- Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA.
| | - Loic Tchokouani
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Diego L Lima
- Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA
| | - Flavio Malcher
- Director Abdominal Wall Reconstruction Program, Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Brian Jacob
- Department of Surgery, Mount Sinai Health System, New York, NY, USA
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Outcomes of redo-transversus abdominis release for abdominal wall reconstruction. Hernia 2021; 25:1581-1592. [PMID: 34287726 DOI: 10.1007/s10029-021-02457-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transversus abdominis release (TAR) is increasingly used to address complex ventral hernias; consequently, associated complications are seen more frequently. Our hernia center has a growing experience with redo-transversus abdominis release (redo-TAR) to address large, complex hernia recurrences after failed TAR. Here, we describe our outcomes after abdominal wall reconstruction with redo-TAR. STUDY DESIGN Adults undergoing elective open, redo-TAR at our institution from January 2015 to February 2021 were queried from a prospectively collected database in the Abdominal Core Health Quality Collaborative. The primary outcome was 30-day wound morbidity. Secondary outcomes were long-term composite hernia recurrence and patient-reported quality of life. RESULTS Sixty-five patients underwent redo-TAR. Median age was 60 years, 50.8% were female, and median BMI 31.8 kg/m2. Median recurrent hernias were 16 cm wide by 25 cm long. Frequent mechanisms of recurrence included linea semilunaris injury (27.7%), mesh fracture (18.5%), infection (16.9%), and posterior sheath disruption (15.4%). Wound complications occurred in 33.8% and 16.9% required procedural intervention. With median clinical and PRO follow-up of 12 and 19 months, respectively, the composite hernia recurrence rate was 22.5% and patients reported significantly improved quality of life (HerQLes: median + 36.7, PROMIS: median - 9.5). CONCLUSION Redo-TAR may be performed as a salvage procedure to reconstruct complex defects after failed TAR, however, in our center, it is associated with increased wound morbidity and fairly high composite recurrence rates. Despite this, patients report improvements in quality of life and pain. Tracking outcomes after TAR will facilitate understanding how to manage its failures.
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Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair. World J Surg 2020; 45:443-450. [PMID: 33025154 DOI: 10.1007/s00268-020-05808-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh. METHODS This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. RESULTS Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed. CONCLUSIONS In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
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Bueno-Lledó J, Ceno M, Pérez-Alonso C, Martinez-Hoed J, Pous-Serrano S. Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two-stage approach of chronic mesh infection. Hernia 2020; 25:1005-1012. [PMID: 33001317 DOI: 10.1007/s10029-020-02309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy of surgical management of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in single-stage approach (complete removal of infected prosthesis and simultaneous replacement with poly-4-hydroxybutyrate mesh or BAM group), comparing results with two-stage treatment (complete mesh excision and abdominal wall repair with synthetic mesh after several months or SPM group). METHODS Retrospective comparative study of all patients who underwent surgery for CMI between January 2006 and January 2019 at a tertiary center. We compared results in terms of epidemiological data, hernia and prosthesis characteristics, surgical and postoperative variables of both two groups. RESULTS Over the 13-year study period, 2791 AWHR was performed at our hospital; the overall CMI rate was 2.5%. Of 71 patients, 30 (42.2%) were in BAM group and 41 (57.8%) in SPM group. The median cumulative operative time (252 min versus 132 min) and length of stay (16.6 days versus 6.2 days) were significatively longer in SPM group compared with BAM group, due to the need of two surgical procedures. There were a higher number of postoperative complications in SPM group (p = 0.002), some of them grade III. With mean follow-up of 36.5 months (range 21-59), there were no significant differences in terms of overall hernia recurrence and mesh reinfection in both groups. CONCLUSION The use of a poly-4-hydroxybutyrate resorbable mesh in single-stage management of CMI may be a safe and better option than two-stage approach, although more studies are needed to confirm our results.
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Affiliation(s)
- J Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain.
| | - M Ceno
- Klinikum Mittelbaden, Balger Strasse 50, 76530, Baden-Baden, Germany
| | - C Pérez-Alonso
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - J Martinez-Hoed
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - S Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
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Recurrence of infection and hernia following partial versus complete removal of infected hernia mesh: a systematic review and cohort meta-analysis. Hernia 2019; 24:433-439. [DOI: 10.1007/s10029-019-02095-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/17/2019] [Indexed: 11/30/2022]
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Augenstein V, Arnold M, Kao A, Gbozah K, Heniford BT. Optimal management of mesh infection: Evidence and treatment options. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2018. [DOI: 10.4103/ijawhs.ijawhs_16_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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